Acupuncture ‘increases IVF success’ by 65%



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February 10, 2008  
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Times – Women who undergo IVF increase their chances of pregnancy if they are also treated with acupuncture, a new analysis suggests.

The benefits may be large — a 65% increase in the chance of becoming pregnant, and a 91% increase in the number of live births.

The results have emerged from a meta-analysis, a technique in which the results of many previous trials are pooled. A team led by Dr Eric Manheimer of the University of Maryland School of Medicine scanned medical literature for trials that attempted to measure the effect of acupuncture on IVF success.

They found 108 trials, but rejected all but seven because of defects of methodology — such as that acupuncture was not administered within a day of IVF or was used as a form of pain relief.

The seven they retained, all published since 2002 and carried out in four Western countries, involved 1,366 women. In all the trials the women were given acupuncture immediately before or after the test-tube embryo was transferred to their wombs. All the acupuncture sessions lasted 25 to 30 minutes.

In British Medical Journal online, the team reports that almost all these trials reported positive findings. Taken together they showed a 65% increase in establishment of pregnancy, an 87% increase in continuing pregnancy, and a 91% increase in live births.

All these results were statistically significant, measured by the criterion of odds of less than one in 20 of having come about by chance. But the team says that these figures overestimate the benefits, since success rates even without acupuncture are relatively high.

It is more realistic, the report says, to measure the results on a “number needed to treat” basis. This is the method that assesses how many women need to be treated to achieve a single extra pregnancy — and the answer is ten.

Even on this basis it is a striking result, especially as nobody has any idea why acupuncture should be having this effect.

Professor Edzard Ernst of Peninsula Medical School in Plymouth said: “On the face of it these results sound fantastic. I would, however, be very cautious as much of the observed effect could be due to a placebo response. IVF may not seem to be ‘placebo-prone’ but it probably is: if women expect it to be helpful they are more relaxed which, in turn, would affect pregnancy rates.”

Success rates in IVF vary greatly from clinic to clinic, and the analysis found that where success rates were high the benefit of acupuncture was smaller and not statistically significant. That may mean that acupuncture was simply a “marker” for clinics where a lot of care is taken to see that women are calm and relaxed.

The team suggests that acupuncture may influence the menstrual cycle, stimulate blood flow to the womb, or produce mood chemicals that reduce the stress response to IVF.

— Acupuncture-like techniques have been used for more than 5,000 years. A comprehensive system was developed in the Far East and was introduced to Europe in the 17th Century

— It is available in most hospital pain clinics and used by an increasing number of GPs and hospital doctors

— Common uses are: pain relief for conditions such as osteoarthritis, pelvic cramps, migraine and back ache; nausea, especially post-operative nausea; menstrual and menopausal problems such as period pains and hot flushes; sinus problems and allergies such as hay fever; skin conditions such as ulcers, itching and rashes

— Placebo-controlled trials have found that acupuncture can help reduce pain, but not much else

— Some studies suggest that real acupuncture is no better than using dummy needles

— One explanation for its success is that small injuries such as needle punctures prompt the body to make endorphins, its natural painkilling chemicals.

[BMJ, doi:10.1136/bmj.39471.430451]